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    1. Anterior Segment Optical Coherence Tomography Angiography of Iris Neovascularization After Intravitreal Ranibizumab and Panretinal Photocoagulation

      Anterior Segment Optical Coherence Tomography Angiography of Iris Neovascularization After Intravitreal Ranibizumab and Panretinal Photocoagulation

      A 58-year-old Japanese man with diabetes presented with blurred vision in his right eye. His intraocular pressure was 53 mm Hg and the peripheral anterior synechia index was around 20%. The anterior segment optical coherence tomography (OCT) angiography image showed that the iris neovascularization was marked around the pupil in the superficial layer ( Figure , A; green shading). 1 Anterior segment OCT angiography using a swept-source OCT system enabled the visualization of physiological radial vessels in the stroma, even in a brown eye ( Figure , A; red shading). Panretinal photocoagulation was administered immediately and completed in 3 separate installments over 1 month ...

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    2. Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy

      Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy

      Importance Wide-field optical coherence tomographic angiography (OCTA) may provide insights to peripheral capillary dropout in eyes with diabetic retinopathy (DR). Objective To describe the diagnostic performance of wide-field OCTA with and without large vessel removal for assessment of DR in persons with diabetes. Design, Setting, and Participants This case-control study was performed from April 26, 2018, to April 8, 2019, at a single tertiary eye center in Singapore. Case patients were those with type 2 diabetes for more than 5 years and bilateral DR diagnosed by fundus imaging; control participants included those with no self-reported history of diabetes, a fasting ...

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    3. Optical Coherence Tomography Angiography Recovery Pattern of Acute Macular Neuroretinopathy

      Optical Coherence Tomography Angiography Recovery Pattern of Acute Macular Neuroretinopathy

      A 73-year-old man had acute vision loss in his right eye, following pacemaker dysfunction during the early postimplantation period. He had second-degree atrioventricular block. Best-corrected visual acuity was 20/63 OD. Anterior segment examination was unremarkable. Humphrey visual field 10-2 testing revealed a paracentral scotoma of the right eye. Fundus photography revealed a brown-reddish foveal reflex ( Figure 1 A). Near-infrared imaging showed a parafoveal multilobular hyporeflective area ( Figure 1 B). Spectral-domain optical coherence tomography (SD-OCT) (Spectralis HRA and SD-OCT; Heidelberg Engineering GmbH) demonstrated hyperreflectivity of the outer plexiform layer and Henle fiber layer associated with subretinal fluid, consistent with acute ...

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    4. Retinal Neovascularization–Simulating Retinal Capillary Reperfusion in Branch Retinal Vein Occlusion, Imaged by Wide-Field Optical Coherence Tomography Angiography

      Retinal Neovascularization–Simulating Retinal Capillary Reperfusion in Branch Retinal Vein Occlusion, Imaged by Wide-Field Optical Coherence Tomography Angiography

      Retinal neovascularization is a complication of retinal vascular diseases, such as diabetic retinopathy, retinopathy of prematurity, and retinal vein occlusion. Anti–vascular endothelial growth factor therapy or laser photocoagulation arrests proliferative retinopathy after neovascularization; however, substantial reperfusion has sometimes been reported. 1 - 3 We report a case of branch retinal vein occlusion manifesting with retinal nonperfusion, covered by retinal neovascularization and appearing as retinal capillary reperfusion. In this case, optical coherence tomography angiography (OCTA) showed distinct neovascularization on the vitreoretinal surface, although there was minimal leakage from the neovascularized area on fluorescein angiography (FA) images.

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      Mentions: Osaka University
    5. Conjunctival and Episcleral Blood Flow Restoration After Strabismus Surgery on Swept-Source Optical Coherence Tomography Angiography

      Conjunctival and Episcleral Blood Flow Restoration After Strabismus Surgery on Swept-Source Optical Coherence Tomography Angiography

      A woman in her 60s presented with hyperexotropia after a recession of bilateral medial rectus muscles for infantile esotropia was performed at age 11 years. She was also experiencing recession of a treatment-naive lateral rectus muscle and advancement of a recessed medial rectus muscle, with a 1 tendon–width downward transposition of the left eye. Swept-source optical coherence tomography angiography (OCTA; PLEX Elite 9000 [Carl Zeiss Meditec]) with a 10-diopter optical adaptor lens was performed on the recessed lateral rectus muscle. The OCTA images suggested that conjunctival and episcleral blood flow decreased immediately after surgery ( Figure , A) but was restored ...

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    6. Pearls and Pitfalls of Optical Coherence Tomography Angiography Image Interpretation

      Pearls and Pitfalls of Optical Coherence Tomography Angiography Image Interpretation

      The advent of optical coherence tomography angiography (OCTA), a relatively new tool to image the retinal and choroidal microvasculature with depth-resolved capability, has been met with great excitement by some ophthalmologists. This noninvasive technology is a potentially valuable instrument to differentiate flow impairment in the superficial vs deep retinal capillary plexus, and it can quantify nonperfusion in eyes with retinal vascular disease. Moreover, OCTA has advanced understanding of the microvascular morphology of choroidal neovascularization and has demonstrated its various growth patterns.  It also has highlighted the potential importance of inner choroidal flow impairments associated with the development and progression of ...

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    7. Clinical Practice Settings vs Clinical Trials Is Artificial Intelligence the Answer?

      Clinical Practice Settings vs Clinical Trials Is Artificial Intelligence the Answer?

      At clinical conferences and in publications, use of the term real world is widespread. It describes physicians’ accumulated experience in treating patients. It is contrasted with academic trials. Randomized clinical trials differ from practice in that they have fixed prespecified inclusion and exclusion criteria, adherence to a prespecified protocol, and ideally good patient retention. Randomized clinical trials have an advantage against observational studies when comparing treatments because they largely control for confounders, bias, and chance. Patient and treatment selection bias, losses to follow-up, outcome measurement, and imaging variability as well as many other confounding and bias factors can have large ...

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    8. Assessing the Use of Incorrectly Scaled Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies

      Assessing the Use of Incorrectly Scaled Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies

      Importance Individual differences in axial length affect the lateral magnification of in vivo retinal images and as a result can affect the accuracy of quantitative measurements made from these images. As measurements from optical coherence tomography angiography (OCTA) images are becoming increasingly used in the diagnosis and monitoring of a wide range of diseases, evaluating which studies use correctly scaled images is crucial to their interpretation. Objective To perform a systematic literature review to assess the percentage of articles that report correcting the scale of their OCTA images for individual differences in retinal magnification. Evidence Review A PubMed (MEDLINE) search ...

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    9. Optical Coherence Tomography Monitoring in a Patient With Retinoblastoma

      Optical Coherence Tomography Monitoring in a Patient With Retinoblastoma

      A 17-month-old girl with group B retinoblastoma in her right eye developed recurrence of a parafoveal tumor ( Figure , A) after 6 cycles of intravenous chemotherapy. Despite treatment with indocyanine green–enhanced transpupillary thermotherapy, optical coherence tomography (vertical orientation) demonstrated continued tumor growth toward the foveola. The patient was subsequently treated with 2 cycles of intra-arterial chemotherapy, after which complete tumor regression to a flat scar was documented clinically and by optical coherence tomography (vertical orientation) ( Figure , B). The foveola remained intact. Optical coherence tomography may be a helpful tool in the documentation of retinoblastoma response, particularly in patients with small ...

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    10. Optical Coherence Tomography Angiography in a Patient With Diabetes and Preretinal Neovascularization

      Optical Coherence Tomography Angiography in a Patient With Diabetes and Preretinal Neovascularization

      A 39-year-old patient with type 2 diabetes (diagnosed in 1996) presented for an evaluation of bilateral proliferative diabetic retinopathy that had been treated previously with panretinal photocoagulation. His visual acuity was 20/25 OD. Examination by ophthalmoscopy showed scattered dot-blot intraretinal hemorrhages and an inferotemporal preretinal neovascular frond ( Figure , A). Optical coherence tomography angiography was also performed ( Figure , B).

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    11. Effects of Flavanol-Rich Dark Chocolate on Visual Function and Retinal Perfusion Measured With Optical Coherence Tomography Angiography

      Effects of Flavanol-Rich Dark Chocolate on Visual Function and Retinal Perfusion Measured With Optical Coherence Tomography Angiography

      Importance A recently reported randomized clinical trial suggested beneficial effects of vasodilating flavanols in dark chocolate on visual function without objective quantification of retinal perfusion. Objective To assess the effects of dark chocolate flavanols on subjective visual function and retinal perfusion objectively quantified on optical coherence tomography (OCT) angiography. Design, Setting, and Participants This randomized, masked double-blind crossover clinical trial analyzed 22 healthy participants at the Department of Ophthalmology, Ludwig Maximilians-University Munich, Germany, in July 2018. Analysis was intention to treat. Analysis began in July 2018. Interventions Participants were randomized to consume 20 g of dark chocolate containing 400 mg ...

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    12. Appearance of Polypoidal Lesions in Patients With Polypoidal Choroidal Vasculopathy Using Swept-Source Optical Coherence Tomographic Angiography

      Appearance of Polypoidal Lesions in Patients With Polypoidal Choroidal Vasculopathy Using Swept-Source Optical Coherence Tomographic Angiography

      Importance Polypoidal choroidal vasculopathy (PCV) is a major cause of visual loss worldwide, particularly in Asia, and the appropriate understanding of the structures in PCV previously described as polypoidal lesions is important for understanding their pathogenesis, diagnosis, and prognosis. Objective To report the morphologic characteristics of polypoidal lesions and their association with branching vascular networks (BVNs) in eyes with PCV using swept-source optical coherence tomographic angiography (SS-OCTA). Design, Setting, and Participants This cross-sectional observational study included 20 participants recruited from Shanghai General Hospital with a diagnosis of PCV based on the presence of focal hyperfluorescent spots on indocyanine green angiography ...

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    13. Sensitivity and Specificity of Potential Diagnostic Features Detected Using Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography for Polypoidal Choroidal Vasculopathy

      Sensitivity and Specificity of Potential Diagnostic Features Detected Using Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography for Polypoidal Choroidal Vasculopathy

      Importance The use of indocyanine green angiography (ICGA) is a criterion standard for diagnosing polypoidal choroidal vasculopathy (PCV), an endemic and common cause of vision loss in Asian and African individuals that also presents in white individuals. However, the use of ICGA is expensive, invasive, and not always available at clinical centers. Therefore, knowing the value of certain features detected using fundus photography (FP), optical coherence tomography (OCT), and fluorescein angiography (FA) to diagnose PCV without ICGA could assist ophthalmologists to identify PCV when ICGA is not readily available. Objective To explore the sensitivity, specificity, and predictive accuracy of potential ...

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    14. Swept-Source Optical Coherence Tomography Angiography of Retinal Arterial Macroaneurysm With Overlying Hemorrhage

      Swept-Source Optical Coherence Tomography Angiography of Retinal Arterial Macroaneurysm With Overlying Hemorrhage

      A patient in their 90s with hypertension and diabetes type 2 noted the sudden onset of decreased visual acuity of 20/70 OS due to a subinternal limiting membrane macular hemorrhage. Blood obscured the view posteriorly, evidenced by blocked fluorescence exceeding 5 minutes on fluorescein angiography ( Figure , A). Swept-source optical coherence tomography angiography (SS-OCTA) demonstrated a retinal arterial macroaneurysm ( Figure , B). The SS-OCTA uses scatter from high-speed acquisition (100 000 A-scans/s) with a long center wavelength (1040-1060 nm), 1 allowing for deep penetration of light through retinal tissue and, in this case, hemorrhage. Although indocyanine green angiography can be ...

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    15. Association Between Parapapillary Choroidal Vessel Density Measured With Optical Coherence Tomography Angiography and Future Visual Field Progression in Patients With Glaucoma

      Association Between Parapapillary Choroidal Vessel Density Measured With Optical Coherence Tomography Angiography and Future Visual Field Progression in Patients With Glaucoma

      Importance Investigating the vascular risk factors of glaucoma progression is important to individualize treatment; however, few studies have investigated these factors because the available methods have proven insufficient to evaluate the vascular features of patients with glaucoma. Recently, the advent of optical coherence tomography angiography (OCT-A) allowed both qualitative and quantitative microvascular data to be obtained, to in turn evaluate the perfusion status of different retinal layers. Objective To determine whether baseline parapapillary choroidal vessel density (VD) as measured by OCT-A was associated with future glaucoma progression. Design, Setting, and Participants A prospective, observational, comparative study was conducted at Seoul ...

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    16. Promise of Optical Coherence Tomography Angiography in Determining Progression of Glaucoma

      Promise of Optical Coherence Tomography Angiography in Determining Progression of Glaucoma

      laucoma is recognized as a multifactorial disease. Although its causality is unknown, damage from glaucoma is highly interlinked to optic nerve and retinal blood flow. 1 Any advancement in the emerging technology of optical coherence tomography (OCT) angiography as a means of measuring optic nerve and retinal blood flow can promote our understanding of the pathophysiologic characteristics underlying glaucoma, improve diagnosis and prognosis, and likely affect the assessment of other ocular diseases.

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    17. Comparing the Risk Factors of Plaque Rupture and Failed Plaque Healing in Acute Coronary Syndrome

      Comparing the Risk Factors of Plaque Rupture and Failed Plaque Healing in Acute Coronary Syndrome

      The article by Vergallo et al 1 in this issue of JAMA Cardiology supports a hypothesis that healed plaques are a marker for reduced acute coronary syndrome (ACS) risk. This commentary expands on this idea by examining a mechanistic hypothesis of their results beyond looking at healing just as a marker. Specifically, failed healing, which correlated in the study by Vergallo et al 1 with long core axial extent, predisposes plaque ruptures to progress to ACS. Acute coronary syndrome may require a double hit of both rupture and impaired healing. This is somewhat analogous to the situation in oncology, where ...

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    18. Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability An In Vivo Optical Coherence Tomography Study

      Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability An In Vivo Optical Coherence Tomography Study

      Importance At one end of the coronary artery disease (CAD) spectrum, there are patients with multiple recurrent acute coronary syndromes (rACS), and at the other end there are those with long-standing clinical stability. Predicting the natural history of these patients is challenging because unstable plaques often heal without resulting in ACS. Objective To assess in vivo the coronary atherosclerotic phenotype as well as the prevalence and characteristics of healed coronary plaques by optical coherence tomography (OCT) imaging in patients at the extremes of the CAD spectrum. Design, Setting, and Participants This is an observational, single-center cohort study with prospective clinical ...

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    19. Optical Coherence Tomography Angiography of Retinal-Choroidal Anastomosis in Toxoplasmosis Chorioretinitis

      Optical Coherence Tomography Angiography of Retinal-Choroidal Anastomosis in Toxoplasmosis Chorioretinitis

      A young adult was examined for follow-up of toxoplasmosis chorioretinitis that was diagnosed and treated during early childhood. Two subsequent flare-ups were treated with atovaquone, combined trimethoprim and sulfamethoxazole, and oral prednisone. Visual acuity was 20/20 OD. Ophthalmoscopic examination results demonstrated an inactive temporal chorioretinal scar with an apparent retinal-choroidal anastomosis ( Figure ). Optical coherence tomography angiography was performed through the anastomosis. Enface images ( Figure ) of the retinal and choroidal circulations confirmed that there was an anastomotic flow between the retinal venous and choroidal circulations ( Figure ). We postulate that this anastomosis resulted from the structural damage that was caused by ...

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    20. Foveal Neovascularization Detected by Optical Coherence Tomography Angiography in Incontinentia Pigmenti

      Foveal Neovascularization Detected by Optical Coherence Tomography Angiography in Incontinentia Pigmenti

      A 5-year-old girl received a diagnosis of incontinentia pigmenti by skin biopsy results. Her best-corrected visual acuity was 20/32 OD. Fluorescein angiography showed nonperfusion and leakage from neovascularization (NV) in the temporal peripheral retina in that eye. Optical coherence tomography (OCT) angiography results showed foveal NV and parafoveal capillary nonperfusion ( Figure ). Another OCT image demonstrated inner retinal thinning that corresponded to the region of parafoveal capillary nonperfusion. Scatter laser photocoagulation was applied to the peripheral nonperfusion areas of the retina.

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    21. Estimating Retinal Sensitivity Using Optical Coherence Tomography With Deep-Learning Algorithms in Macular Telangiectasia Type 2

      Estimating Retinal Sensitivity Using Optical Coherence Tomography With Deep-Learning Algorithms in Macular Telangiectasia Type 2

      Importance As currently used, microperimetry is a burdensome clinical testing modality for testing retinal sensitivity requiring long testing times and trained technicians. Objective To create a deep-learning network that could directly estimate function from structure de novo to provide an en face high-resolution map of estimated retinal sensitivity. Design, Setting, and Participants A cross-sectional imaging study using data collected between January 1, 2016, and November 30, 2017, from the Natural History Observation and Registry of macular telangiectasia type 2 (MacTel) evaluated 38 participants with confirmed MacTel from 2 centers. Main Outcomes and Measures Mean absolute error of estimated compared with ...

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    22. Assessment of Postoperative Morphologic Retinal Changes by Optical Coherence Tomography in Recipients of an Electronic Retinal Prosthesis Implant

      Assessment of Postoperative Morphologic Retinal Changes by Optical Coherence Tomography in Recipients of an Electronic Retinal Prosthesis Implant

      Importance The postoperative retinal changes at the interface between an implant electrode array and the retina and whether these anatomic changes have an association with the patient visual performance are unknown. Objective To report morphologic changes in recipients of an Argus II Retinal Prosthesis. Design, Setting, and Participants This consecutive, noncomparative case series study included a retrospective review of the preoperative and postoperative optical coherence tomography of 33 eyes among 33 individuals who underwent Argus II Retinal Prosthesis System implantation between October 28, 2011, and June 8, 2017, at 2 different centers, by the same surgeon (S.R.). Thirteen patients ...

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    23. Optical Coherence Tomography to Assess Anatomic Changes in Recipients of Electronic Retinal Implants Getting Closer to the Promised Land of Sight for All

      Optical Coherence Tomography to Assess Anatomic Changes in Recipients of Electronic Retinal Implants Getting Closer to the Promised Land of Sight for All

      They came to Bethsaida. Some people brought a blind man to him and begged him to touch him. 23 He took the blind man by the hand and led him out of the village; and when he had put saliva on his eyes and laid his hands on him, he asked him, “Can you see anything?” 24 And the man looked up and said, “I can see people, but they look like trees, walking.” Mark 8:22-24 1

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    24. Vertical Hyperreflective Lesions on Optical Coherence Tomography in Vitreoretinal Lymphoma

      Vertical Hyperreflective Lesions on Optical Coherence Tomography in Vitreoretinal Lymphoma

      Importance Vitreoretinal lymphoma is a diagnostic challenge and the pathophysiology is still unclear. Objective To describe an imaging finding seen on optical coherence tomography (OCT) of patients with vitreoretinal lymphoma. Design, Setting, and Participants This case series study was a retrospective medical record review of patients who received a diagnosis of vitreoretinal lymphoma at the Department of Ophthalmology at Northwestern University between July 2014 and January 2016. Main Outcomes and Measures Optical coherence tomography findings in vitreoretinal lymphoma. Results We identified 7 patients (4 women [57.1%]; mean [range] age, 62.4 [45-75] years; 12 eyes) with intraocular lymphoma involving ...

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